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Park City • The film world loves hyperbolic terms such as "explosive material," but that description is more than figurative for the Sundance Film Festival documentary "After Tiller."

The bracing, 85-minute journey into the heart of the abortion debate is the only film among this year's line-up to require its own retinue of arms guards, plus a full security check, during its Friday world premiere at Park City's Temple theater.

It's risk enough when the namesake of a film is Dr. George Tiller, the Kansas physician assassinated in 2009 during a service in his Wichita church. When the only four doctors performing late-term abortions in the United States show up at the world-premiere screening for a question-and-answer session with the audience, filmmakers don't take any chances.

Directors Lana Wilson and Martha Shane, both 29, are first-time filmmakers who worked for nearly three years on the film. "We felt good about it (the security at the premiere)," Wilson said. "It meant we could exhale."

Shane added: "The doctors are the best spokespeople for this issue, so of course they had to be there and be safe."

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Abortion then and now • Shane and Wilson's film arrives on the cusp of the 40th anniversary of Roe v. Wade, the Jan. 22, 1973, U.S. Supreme Court decision legalizing abortion. It also comes on the heels of a recent Pew Research Center poll showing that a majority of Americans under 30 aren't aware of the landmark case.

Even as the issue continues to be part of the nation's ongoing "culture wars" debate, it appears to be something of a moot point for younger generation who has taken legal abortion for granted. Some speculate that's because the procedure is increasingly carried out through abortifacient medicines at the earliest stages of pregnancy.

"After Tiller" focuses on the estimated less than 1 percent of all abortions that take place in the "late" third trimester, between week 25 and 28 of a pregnancy. It's also estimated that the majority, 80 percent, are performed after parents learn that their child will be born with rare, devastating medical conditions that make life for the child unbearable, or not viable, soon after they're born. Unlike abortions in the early stage of pregnancy, "After Tiller" makes it clear that late-term abortions are performed almost as still births, with the baby euthanized and labor induced.

Only nine states allow the procedure. After Tiller's murder in 2009, only four American physicians continue to perform it. Shane and Wilson profile these physicians and chronicle their workday lives.

LeRoy Carhart is the frumpy, always collected physician with a stalwart wife for his assistant. His stable was burnt down in 1991 in retribution for his abortion practice, taking with it the lives of 17 of his horses. With late-term abortions made illegal in his native Nebraska, Carhart searched for an office lease in Iowa before settling in Maryland, trailed by protesters every step of the way.

Shelley Sella, who was a midwife before she became a doctor, and Susan Robinson, who practices with one eye on compassion and another on no-nonsense pragmatism, both worked for Tiller in Wichita, Kan. Now the pair maintain offices in New Mexico, where they counsel and treat women who sometimes travel across the country for their services.

Warren Hern proves the most wry-humored of the bunch, a doctor who endures bullets shot through his office door, harassing phone calls to his elderly mother, and the breakdown of his first marriage under the pressure of his chosen profession. He remains resolute throughout, having spent years in Latin America, where abortion remains illegal and women are likely to die after botched attempts of their own.

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Patients and conscience • As Shane and Wilson move film cameras in-and-out of the doctors' offices, all four physicians prove themselves caring and conscientious.

Procedures aren't filmed. Instead, viewers watch gut-wrenching sessions of patient counseling, where patients and their partners are rendered anonymous by camera angle or obfuscation. In these sessions, viewers can't escape the fact that professionals are guiding people through agonizing decisions from which some will never escape unscathed.

"It's guilt no matter what you do," says one faceless woman off-camera in Sella's office. "It's guilt if you do what we're doing here, and it's guilt if we bring him [our baby] into this world and he has no quality of life."

There are times when the doctors' patients become almost a collective, central character in "After Tiller," depicted through the body-language of holding hands, fidgeting fingers and feet, and the use of box-after-box of tissue.

"It shows you how perverse it is that this issue ends up in Legislatures," Wilson said at a press conference.

One patient speaks to Robinson through tears about Hudson, her baby boy who  unless she aborts  will live a life of "shunts, surgeries and seizures" due to his rare medical condition. Doctor and patient talk of how when she says hello to her child for the first time that's also when she will say goodbye.

One 16-year-old girl travels from Reno to Robinson's office in Albuquerque in search of advice, resulting in a conversation between Robinson and a counselor similar to what might be heard from the pro-life protesters outside her office building.

In one key scene, after Robinson's assistant announces she wants nothing more to do with the teenager, because she's confident the girl will regret her decision, Robinson takes the reigns. Protecting women from regret is wonderful, were it only possible, Robinson tells her assistant. What matters is determining if a patient is committed to a decision, and whether a physician can treat that patient safely.

"Who am I to decide if [a woman] has a great story or not?" Robinson asks. "Women are able to struggle with complex issues for themselves and arrive at a decision."

There are times "After Tiller" transcends its subject by offering poignant, heart-rending consideration of how any life decision, abortion or not, changes perspective over time.

Decisions are always based on knowledge anchored in the present time, because that can be known. The comfort of wisdom and the pain of regret are left to future hindsight. "Remember why you made your decision now, because time changes it," Sella advises her patients.

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Bringing a difficult film to market • Audience members at Friday's premiere of "After Tiller" asked the filmmakers how they planned to bring their remarkable, difficult documentary into the mainstream market. The film market loves controversy, and controversy has followed the issue of abortion continually, Shane and Wilson said.

While both Shane and Wilson are themselves pro-choice, both said they never wanted to make a polemic. "We wanted a movie that looked at those gray areas," Shane said. "We wanted as intimate a film as possible."

The subjects of their film will, of course, continue to speak for themselves.

Hern, for one, made his allegiance clear: As security guards on either side of him kept watch, he told audience members they can best understand the dynamics of the ongoing debate by reading Machiavelli.

"This is about power  who has it and who doesn't," Hern said. "It's about who decides: the woman, or the state. This is a war on uppity women."